BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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          |SENATE RULES COMMITTEE            |                       AB 1570|
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                                    THIRD READING


          Bill No:  AB 1570
          Author:   Chesbro (D)
          Amended:  8/18/14 in Senate
          Vote:     21

           
           SENATE HUMAN SERVICES COMMITTEE  :  4-0, 6/24/14
          AYES:  Beall, DeSaulnier, Liu, Wyland
          NO VOTE RECORDED:  Berryhill

           SENATE APPROPRIATIONS COMMITTEE  :  5-0, 8/14/14
          AYES: De León, Hill, Lara, Padilla, Steinberg
          NO VOTE RECORDED: Walters, Gaines

           ASSEMBLY FLOOR  :  79-0, 5/28/14 - See last page for vote


           SUBJECT  :    Residential care facilities for the elderly

           SOURCE  :     California Assisted Living Association
                      California Council for the Alzheimers Association
                      LeadingAge California


          DIGEST  :    This bill, effective January 1, 2016, requires the  
          certification program for an applicant for licensure of a  
          Residential Care Facility for the Elderly (RCFE) to consist of  
          100 hours of course work and a state-administered examination of  
          no less than 100 questions; requires the examination to reflect  
          the uniform core of knowledge required and requires the  
          Department of Social Services (DSS) to, every other year, review  
          and revise the examination to reflect changes in law and  
          regulations; changes the certification fee to an amount not to  
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          exceed $150 and requires staff members of RCFEs who assist  
          residents with personal activities of daily living to receive 20  
          hours of training before working independently with residents,  
          an additional 20 hours within the first four weeks of  
          employment, and an additional 20 hours annually, as prescribed;  
          and applies the training requirements specific to dementia care  
          to all RCFEs. 

           ANALYSIS  :    Existing law:

          1.Establishes the Residential Care Facilities for the Elderly  
            Act (Act), which provides for DSS to license and regulate  
            RCFEs as a separate category within the existing residential  
            care licensing structure of DSS. 

          2.Requires a license applicant and an RCFE administrator to  
            successfully complete a certification program approved by DSS,  
            which includes a minimum of 40 hours of classroom instruction  
            including a uniform core of knowledge, as specified. 

          3.Specifies that an RCFE administrator certification is valid  
            for two years and that recertification requires 40 hours of  
            continuing education. Provides through regulation that an  
            applicant for licensure is required to meet the requirements  
            for initial certification of administrators. 

          4.Provides that the initial certification of administrators  
            shall include successful completion of a department-approved  
            program, passage of a written test administered by DSS within  
            60 days, and a criminal records clearance. 

          5.Requires DSS to develop requirements for a uniform core of  
            knowledge for the initial certification and continuing  
            education requirements for licensees, administrators and staff  
            of RCFEs. Provides that this knowledge base shall include  
            basic understanding of the psychosocial and physical care  
            needs of elderly persons. 

          6.Provides that RCFE staff members who assist residents with  
            activities of daily living shall receive at least 10 hours of  
            initial training within the first four weeks of employment and  
            at least four hours annually thereafter. 

          7.Requires DSS to develop a uniform assessment tool to be used  

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            by all RCFEs in identifying resident needs for service and  
            assistance with daily living. 

          8.Requires facility personnel to be sufficient in numbers and  
            competent to provide the services necessary to meet resident  
            needs.  Provides that DSS may require any facility to provide  
            additional staff whenever if determines through documentation  
            that the needs of the particular residents, the extent of  
            services provided, or the physical arrangements of the  
            facility require additional staff. 
           
           This bill:

          1.Increases the required licensee certification training to 100  
            hours of coursework, at least 60 hours of which is required to  
            be attended in person.

          2.Expands the required state-administered examination to no less  
            than 100 questions, increases the fee submission to no less  
            than $150, and allows an applicant to have access to the RCFE  
            Act and related regulations, during the examination. 

          3.Expands the required uniform core of knowledge to additionally  
            include:

             A.   Medication management, including use, misuse, and  
               interaction of drugs commonly used by the elderly,  
               including antipsychotics, and the adverse effects of  
               psychotropic drugs for use in controlling the behavior of  
               persons with dementia.

             B.   Managing Alzheimer's disease and related dementias,  
               including nonpharmacologic, person-centered approaches to  
               dementia care.

             C.   Managing the physical environment, including maintenance  
               and housekeeping.

             D.   Residents' rights, and the importance of initial and  
               ongoing training for all staff to ensure residents' rights  
               are fully respected and implemented.

             E.   Cultural competency and sensitivity in issues relating  
               to the underserved, aging, lesbian, gay, bisexual, and  

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               transgender community.

             F.   Postural supports, restricted health conditions, and  
               hospice care.

          1.Requires DSS, no later than July 1 of every other year, to  
            review and revise the examination in order to ensure the rigor  
            and quality of the examination, and to ensure, on an annual  
            basis, that the exam is not in conflict with existing law.  
            Permits DSS to convene a stakeholder group to assist in  
            developing and reviewing test questions.

          2.Requires DSS to adopt regulations to require staff members of  
            RCFEs who assist residents with personal activities of daily  
            living to receive appropriate training consisting of 40 hours  
            training.  Specifies that a staff member shall complete 20  
            hours, including six hours specific to dementia care and four  
            hours specific to postural supports, restricted health  
            conditions, and hospice care, before working independently  
            with residents.  Specifies the remaining 20 hours shall  
            include six hours specific to dementia care and shall be  
            completed within the first four weeks of employment.  Permits  
            the training coursework to utilize various methods of  
            instruction, including, but not limited to, lectures,  
            instructional videos, and interactive online courses.   
            Requires the additional 16 hours to be hands-on training. 

          3.Requires, in addition to the above, training requirements to  
            also include an additional 20 hours annually, eight hours of  
            which are required to be dementia care training, four hours of  
            which are required to be specific to postural supports,  
            restricted health conditions, and hospice care.  Requires this  
            training to be administered on the job, or in a classroom  
            setting, or both, and may include online training.

          4.Clarifies that all RCFE direct staff are required to meet the  
            following training requirements:  twelve hours of dementia  
            care training, six of which shall be completed before a staff  
            member begins working independently with residents, and the  
            remaining six hours of which are required be completed within  
            the first four weeks of employment. 

          5.Permits DSS to establish the subject matter required for the  
            training in consultation with provider organizations and adds  

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            the following to the currently required topics:

             A.   Dementia care, including the use and misuse of  
               antipsychotics, the interaction of drugs commonly used by  
               the elderly, and the adverse effects of psychotropic drugs  
               for use in controlling the behavior of persons with  
               dementia. 

             B.   The special needs of persons with Alzheimer's disease  
               and dementia, including nonpharmacologic, person-centered  
               approaches to dementia care.

             C.   Cultural competency and sensitivity in issues relating  
               to the underserved, aging, lesbian, gay, bisexual, and  
               transgender community.

          1.Specifies the above provisions do not apply to certified nurse  
            assistants, licensed vocational nurses, and registered nurses,  
            with specified exceptions. 

           2. Makes the above provisions operative on January 1, 2016.

           Background
           
           Residential Care Facilities for the Elderly.   Within  
          California's continuum of long term care, situated between  
          in-home care and skilled nursing facilities, is the RCFE, also  
          commonly called Assisted Living, Board and Care, or Residential  
          Care. There are approximately 8,000 Assisted Living, Board and  
          Care, and Continuing Care Retirement homes that are licensed as  
          RCFEs in California. These residences are designed to provide  
          homelike housing options to seniors and other adults who need  
          some help with activities of daily living, such as cooking,  
          bathing, or getting dressed, but otherwise do not need  
          continuous, 24-hour assistance or nursing care. Increasingly  
          residents are entering RCFEs with significant health needs  
          including diabetes, bedsores, or require the use of oxygen  
          tanks, catheters or colostomies.

           Licensee and Administrator training requirements.   Existing law  
          requires prospective licensees and facility administrators to  
          complete a certification program approved by DSS consisting of  
          40 hours of classroom instruction. 


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          Typically, the 40-hour training requirements are met through  
          private vendors who have been approved by DSS to conduct these  
          trainings.  The courses are generally scheduled as four,  
          consecutive, 10-hour-day trainings, costing approximately $200  
          to $300.  Following the training, prospective administrators are  
          required to pass a 40-question test administered by DSS that has  
          not been changed since its initial release.  Approximately 500  
          individuals take the exam every month.  Reportedly, the several  
          versions of the test are available online to be studied in  
          advance and few individuals fail the exam.  Licensees must only  
          pass their initial certification and are not required to  
          maintain a current certification, which expires after two years.  


          Additionally, corporate owners of a facility, who are not the  
          official licensee, are not themselves required to be licensed or  
          have any training despite having financial and managerial  
          control over the facilities they manage. 

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

          According to the Senate Appropriations Committee:

           Significant one-time and ongoing costs potentially in excess  
            of $350,000 (General Fund) for DSS to develop and revise  
            regulations, review and approve certification programs,  
            administer and periodically revise the examination for RCFE  
            licensees, and establish the subject matter required for  
            training for direct care staff.  These costs would be offset  
            by the increase in fee authority. 

           Significant increase in training costs to employees and/or  
            facilities to meet the enhanced initial and continuing  
            education training requirements imposed. 

           Potential minor non-reimbursable local enforcement costs for  
            misdemeanor violations of the provisions of the Act pursuant  
            to this measure. 

           SUPPORT  :   (Verified  8/18/14)

          California Assisted Living Association (co-source) 
          California Council for the Alzheimer's Association (co-source) 

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          LeadingAge California (co-source) 
          ActivCare Living
          Belmont Village Senior Living
          Brookdale Senior Living
          Byron Park Senior Living
          California Commission on Aging
          Cal PACE
          Capriana Senior Living
          The Carlisle
          Chancellor Place of Murrieta
          Chancellor Health Care, Inc.
          Congress of California Seniors
          Cypress Place Senior Living
          Emeritus at Alhambra
          Emeritus at San Juan Capistrano
          Huntington Terrace Senior Living
          Inn at the Park Senior Living
          MBK Senior Living
          Mirage Inn Senior Living
          Sandi Flores, RN
          The Stratford
          Sierra Pointe Vintage Senior Living
          Sunrise Senior Living of Beverly Hills, La Jolla, Mission Viejo,  
          Oakland Hills, Studio City, Westlake Village, and Yorba Linda
          Vintage Golden Gate
          
           OPPOSITION  :    (Verified  8/18/14)

          Community Residential Care Association of CA
          Consumer Advocates for RCFE Reform


           ASSEMBLY FLOOR  : 79-0, 05/28/14
          AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,  
            Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian  
            Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,  
            Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,  
            Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon,  
            Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hernández,  
            Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,  
            Maienschein, Mansoor, Medina, Melendez, Mullin, Muratsuchi,  
            Nazarian, Nestande, Olsen, Pan, Patterson, Perea, John A.  
            Pérez, V. Manuel Pérez, Quirk, Quirk-Silva, Rendon,  
            Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner,  

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            Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, Atkins
          NO VOTE RECORDED: Vacancy


          JL:nl  8/18/14   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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